HomeMy WebLinkAboutBuilding Permit Application 05/12/2016 THU 14:48 FAX 0001/004
ALL APPLICA (NFO M�JST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: c-;_, Permit Number: I�
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Legal Description: C_N >e$Grz 1DG� C'Grv:It-It N l
Property Tax ID##: -,-i 17n i Lot No.,--
Site
o:Site Plan Name: ATT- Block No.
Project Name: AT"T-
Setbacks Front Back: Right Side: Left Side:
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L—Additional work toe e orme under this permit-check ma»
R HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors r
MElectric Plumbing []Sprinklers Generator Roof
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$_ J�pdf Utilities: SewerSeptic Building Height:
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Name ,!r oil 6964 �' Name:- 171G 4l6#FIN4 ,. Ove
Addres i4o-6nur pany: M" 190,V ✓raA/
City: bl 'M State. (v Address: Z683 Xa"/2, 49 S7"h
Zip Code: q_b ax: / City:`]/el"4O12/_ 9 Stater
Phone No., �2- lU C Zip Code: 3Z�3S Fax: 3W- 90-a95e
E-Mail: Phone No. 3ZA ?55. G88n?3
Fill in fee simple Title Holder on next page(if different E-Mail: DYNI4�K/GLI�HT/NG lrr/QE�GSGLI� /U��
from the Owner Ps!cd,alpue) !`zt�:or County Mcei:se:J`lr_
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
........................... ..........._..........._..
05/12/2016 THU 14:48 FAX 11002/004
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: ate: City: State:
Zip: Phone: Zip: P e
FEE SIMPLE TITLE HOLD . _Not Applicable BONDINGC PANY: _Not Applicable
Name: Name:
Address: - Addres
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recqrkd and posted on the jobsite
before the first inspection. If you intend to obtain financing,consult w' en er or an ney before
commenAg work or recording our Notice of Commencement.
144 Le
s
ignature of Owner/Lessee/Agent a tureoft a /Li nse Hol r
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF � /1�d/111D COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this J;Z day of 20/�__Iby this !Z day of AY4 .20 /6 by
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(Name of person acknowledging) (Name of person acknowledging)
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(Sig ature of NotaryPublic-PuSi n
/blic-State of Florida) ( ature of Notary Public-State of Florida)
Personally Known V OR Produced identification Personally Known�R Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission N
LOUIS K LATUUPPE It ZOB 1� 9 ”public-dtatif a!Florida
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Commlaalon•FF 969067 a�lJoli llo @lelg•oNaad�noN .
Revised 07/15/ .a My Comm.ERplraa May 29,2020 113dd11fUtl19 91f101 .,,N;,,••``��
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION, SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE ,
COMPLETE
INITIALS